fireflymedic

Richard - swan attacked a baptist healthcare helicopter in Arkansas. Did such a similar thing that I seriously thought it was the same incident. Flew through the windshield breaking it and hitting the pilot cutting his face. Bird was stuck in the front end of the helicopter. Didn't turn out too well for it.

glad to see ya back firedoc -

Man, the birds are getting aggressive these days. First the swan in Arkansas attacks, and now duck in FL. Should we start to carry animal control on all flights? Kudos to the pilot for keeping everyone safe.

Get well soon Firedoc ! We miss ya around here !

Well put RR911. I'm a big fan of NPA's as well (as you can tell from prior posts). I don't see the need to prolong seizure activity nor chase a vein in a seizing patient. Is why in this area they are pursuing doing an IM versed as opposed to IV ativan, in addition to the fact we have the ability to use IN. With use of MAD - I really don't see the reason to chase a vein. It's not easy getting an IV in an actively seizing patient, so I definitely see the benefit to going IN over any other route. Remember it is the same mucuous membrane absorbtion as with peds going rectally. Never mind many of your frequent seizure patients also have home diastat (rectal valium gel) in case of status epilepticus or clustered seizures. If we remember correctly, absorbtion through the mucous membrane is the second fastest method, so perhaps we should be thinking in terms of quickest absorbtion as opposed to what we are trained like monkeys to do. Just something to consider IMHO. Stay safe. Also, RR - I was referring to a post intubation care. Versed is going to carry your anti seizure properties. Diprivan doesn't as much and used more for sedation, though I've frequently seen patients that were refractory put on diprivan drips in an attempt to slow their brain down enough to chill out. Just a fun afterthought.

Etomidate is still frequently used for induction, however, I would be more preferable to use Versed for the pure and simple fact it is going to help suppress seizure activity. If you have the capability, versed drip is preferable to diprivan as diprivan can be a bitch of a drug for transport, though in hospital it is alot more stable. I have seen versed, ativan, and diprivan (propofol) all used for drips for status seizure patients. It is just difficult to maintain a proper titration for propofol (titrate to effect) and maintain sedation. I've seen plenty of patients who were't adequately sedated on diprivan alone. I'm more of a versed drip fan for it's anti seizure properties (I've actually seen several patients seize coming off a propofol drip and it have to be restarted, it's biggest perk is it is quick on and quick off) and then fentanyl for comfort as tubes aren't the most comfortable thing around. That is my personal thing. Take my opinion as you will. Also, point of interest - ativan is the drug of choice for seizure management as it has the longest half life of any of the meds. Valium is the shortest, so something to consider. With valium, I've found many patients to be fairly resistant, or to be controlled temporarily, then go on to seize again requiring an additional dose, so if I have the option, it's ativan or versed since I've got long transports. Take care, stay safe.

I'm not on facebook, but it's good to know your lookin out for us. Thanks for the info !

Thanks ! That's a great link to pass on to students. Good find !

Defintely get to a sports med doc who has a good handle on knees and do some rehab with sports med specific people if you can (they can be an awesome resource !). As far as any site. Knee Guru is a good resource, but get her eval then check up on the exercises there if you want ! Good luck !

For anyone with affiliations or that works closely with Bayflight, North Texas Lifestar, or Vanderbilt Lifeflight - my sympathies on the recent passing of Kevin Grossman. He was an amazing caregiver - a true educator as well. Would teach anyone willing to listen about anything with a great sense of humor. He passed away Feb 28 in FL.

Okay, I'm seriously starting to think this thread needs to die. It's going from a funny discussion, to some education, to now a peeing match. Gentleman, zip your pants !

Doc - point well taken. My concern would not be so much with the individual, it would be more the length of time since the incident and stability since then. I do believe past performance is a good indicator of future, however, I'll be the first to state there are many factors involved. If the incidents were a direct or indirect result of the job or an incident, I would definitely want a verification that the person was adequately treated and as with any physical problem I would request a return to work statement. If cleared by their treating physician, then yes, I would have no problem employing them (provided it was not immediately following the incident). If the person is actively already on the department, I don't propose firing them, but moving them into a different role within the department as you would a physical issue and discuss with med director and their treating doc time of appropriate return. All parts working together for sure ! I think if this attitude were taken with more employers there would be a bigger push for employees to take care of themselves without reprimand. As far as the HIPPA thing, I know that is frequently violated. I've had people come to me multiple times saying did you know this or that or I picked up so and so the other day what are you going to do about it? If it is something of concern, I'll address it with the individual privately and find out the situation, but most of the time, I'll just tell people move on and mind their own business. It's all about respect to ALL patients people. Thanks for the good insight.

Man, I'm with dallas - if I could take you out and buy you a beer I would. I had this exact discussion with someone last night as we both have hit an extremely frustrating point seeing the quality of future providers and what we have to deal with now. Even at the state level, there is no desire to change, at the national level, there is no push. Everyone is content to be just that - a freakin ambulance driver not a medical professional. Those of us that actually do aspire to be better and really make something of ourselves and treat our patients with respect seem to be pulled to the bottom of the profession and those who are half way providers are the ones making progress (or at least in this area and I'm sure it's like this many places). We don't demand respect, and until we do, it's not going to change. The problem is, people aren't willing to drop the dead weight and go through the tough time of replacing it with quality professionals, so we stay in this horrible stalemate. I hit the point you are several years ago, and a 6 month vacation from EMS helped. I realized I did really love what I did, but it didn't stop the frustration I still feel from time to time even though now I work for a good provider. I just realized that this was what I had chosen to do, and that if I didn't like it I either needed to walk away and fear the day I was picked up by one of these sub par crews, or to stay and do my best to change it even if that meant making some people uncomfortable. Perhaps if I changed a few people here and there, one by one maybe we'd see a difference. Best wishes.

Want to know the thought on RSI and making sure your patient is completely sedated as well - seriously watch this. It's not to bash any provider, but to bring some thought and awareness. I know RSI has been hashed out here several times, but I really thought this was worth sharing. http://www.youtube.com/watch?v=bLSnXiegIgk...feature=channel

Wow, that is totally unacceptable. People call 911 (the legit ones at least) because they need immediate attention not 10 hours from now ! Typically when we call in, we are given a room assignment prior to arrival and that keeps thing running pretty smooth in general. Yes we get backed up, but on average I've never had to wait more than 20 min and that was with a b.s. patient. Granted I have seen stretchers in every way shape form and direction in the halls even two in the nurses station ! Only if we don't call in, or if they have several major traumas hit them at once does it take very long. Typically walk in, hit the buzzer, go to your preassigned room (or hallway) and hand them over. Even private hospitals aren't that bad. Now if you are out in the waiting room, well, you might be waiting QUITE a while !

Potential Rh incompatibiltiY?

Wow - that is quite the set up. Here things are a bit different depending upon where we go, but I'll focus on university as I have worked there and am most familiar with it and take patients there the most. 6 Trauma rooms (we are only trauma center in this region of the state plus take alot of referring stuff from neighboring states) - 2 are "CODE RED" traumas requiring major resuscitation (typically if you come in via flight and are intubated with significant blood loss this is where you will go - or if ground designates you a code red, then you'll go there as well - all burn patients fit this criteria unless minor burns). We have 4 critical areas which each have their own supply cabinets fully stocked at all times and are curtain partitions. The two code red rooms are sliding glass door style and can be adjusted to whatever the needs of the patient. Typical equipment in code red rooms which may be borrowed out to the other areas as needed Ultrasound Vent (respiratory automatically responds to any code red or intubated trauma) mobile X ray (they are automatic response as well) Vitals monitors Crash cart It's own fully stocked pyxis with swipe card access Fiberoptic/difficult airway equipment (anesthesia's usually along for the ride as well) ability to accomodate stretcher/hospital bed to a traction set up if needed then dedicated CT scanner and MRI for just trauma/stroke patients dedicated transport team within hospital for transfers between areas plenty of residents, interns, med students, paramedics, rn's and even a really grouchy attending depending on the night ! We do pretty well here

Hey there, Everybody makes mistakes. I think you are doing the smart thing by just laying low for the time being. Perhaps a service a little farther out may be willing to take a chance on you after graduation? I'm not sure of the hiring situation in your area, but it might be worth looking into. ER alot of times is harder to get hired onto, at least here because the hours and pay are better. Keep your head up though, do con ed, ask if you can do some volunteer ride time with a service to kinda prove yourself to a service if possible once certed. Get involved with a rescue squad if possible. Then use that to develop a professional rapport with the EMS profession. Get a good reputation as one willing to learn and sharp on their feet and send in a letter of reference with your application and that may help your cause for sure. In general, I've found that alot of employers given enough time and proving of yourself that it was a one time occurrance, and not a frequent issue, they will be willing to give you a chance. Just be patient, hang in there, and keep learning and most important dont do anything else dumb ! General rule for most services is either three or five years until they will dismiss it. Some transport services may hire you, but not allow you to drive, so that is something else to discuss. Best wishes.

I'm still pretty suspicious of shaken baby syndrome - thinking if shaken around enough we could have some kidney damage as well. However, throwing a wild one out there but that could fit the bill is polycystic kidney disease. Sometimes presents with intracranial bleeds - so have to admiit that's sitting in my head especially if things fit the bill. Let's get a realistic picture of this kid's kidney function as well. Oh BTW, I'm pulling whatever doc is deciding to be doing something more important and getting his opinion. I'm a medic not a doc ! According to NR - I don't diagnose I just treat (yeah right ya can't treat properly unless you have some idea of what's going on). So let me have a little more info - CT of kidneys - we see any cysts there? I know it's a wild ballgame, but I'm gonna play it though SBS is pretty strong too.

Hmmm, Do we see any odd signs with the baby? Bruises that shouldn't be there? Odd marks? What are the parents reactions to the situation? Do they seem appropriately concerned? Overly apologetic? Apathetic? I'm thinking these guys from history may have had this baby and are feeling just a little overwhelmed and that may have resulted in some shaken baby here ! A head bleed could certainly account for the unequal pupils and bulging fontanelle. As far as treatment, I'm gonna go aggressive with this kid. I want definite IV access (if I can't get it, you better believe I'd go IO), and with isolated head injury possibly consider mannitol (even though I know it's getting pulled off more and more trucks). If kid seizes again, consider some benzos and I'm gonna be prepared to take care of the airway if needed, but I'll only tube if I have to (bag 'em if you have to, tube them only if you must). I'm not thinking febrile seizure here - wouldn't account for some things. Tell me more of what I want to know and I'll tell you what else you might get. As far as letting mom and dad stay with the kid, I'd be hesitant, especially if I can separate them calmly. In general they probably aren't good candidates to have around with a kid going down the tubes and I prefer to keep things as calm as I can. Oh, BTW, at the hospital, if findings confirm my suspicions, I'll be having a chat with the ER doc 'cause I'm seriously believing one of the parents got overwhelmed with a new crying baby and just couldn' t make it stop, snapped, and didnt realize the damage they did until now. I've seen more than one case like this and this is reminding me too much of a run I made not long ago which fit the criteria. I could be way off here, but it's sounding mighty close. Oh and BTW - can I add a transfer to an appropriate facility either via bird if available to fly or I'll take ground either way this baby needs a pedi neuro and it's not looking like we're gonna get it here !

Lone So very very true, I would have actually preferred most of the time to NOT have had that stuff in my personal possession to worry about. As far as intending to use it on "real" patients. Yep, our rules were if we broke open our seal, then WE had to accompany the patient on the ambulance and sign the run sheet as the attendant even if there was another medic present to take care. That was just the way it was. Other services may act differently, but that's how it was for us. I'm not seeing much wrong with that direction to take either. As far as this guy, hes just outta control and needs someone to slap him upside the head. I thought this was a joke a first glance, sad to realize it wasn't 'cause I got a good laugh outta it.

I know of someone (not myself by any means, so please do not take this questioning as such) that is currently looking to get into the EMS profession however, they have a history of mental illness marked by 2 suicide attempts over 5 years ago. One attempt resulted in emergency detainment and a brief stay in a psych hospital. The person has completed their basic EMT and did well, and also has completed significant amount of counseling following the situation which resulted in the mental disability. My questioning is I would be questionable hiring someone with a known history of this, but yet I feel it unfair to judge them on the past as I feel many people make mistakes or have things beyond their control happen and are able to overcome them as may be the case here. Then again it may not be. Would one be wrong in not hiring the individual and if so, how would you appropriately decline employment without requiring a psych exam prior to employment? Would you personally hire the person? If so, why or why not? I'm looking for ideas here as I know suicide and depression have been discussed in a round about way on here, but never a direct answer of whether you would hire someone with a psychiatric history or not. Thanks for the response. Stay safe and well.

Hmmm, well here are my thoughts on this. 1. You can have whatever you want (within legal reason) to keep in your car/on your person so long as you don't present yourself as being able to use it or actually use it. So if you want bags of IV fluids and a ton of caths, that's just dandy, you just better not ever use 'em without med direction. 2. In some areas medics do keep ALS kits for themselves as they have extreme response times and if they live way out in the county, they will respond often times before EMS can. In those situations, they are considered on call and covered by the med director. I used to be in this situation, so I am aware of certain places which do, however, they are a rarity and your med director better damn well trust you ! 3. If you work extreme wilderness camps (like the kid boot camps or extreme retreats like survivor type scenario) or as a sherpa whatever where medical response could be significantly delayed, due to weather or location or even situation, yes I could see something of this type being practical (though perhaps not this in particular) and ALWAYS used by someone with appropriate training though I think that goes without saying. Other than that, this person is an idiot and needs to be turned into the state med board for at the least, possessing the meds with an intent to distribute. 300 mg vial of morphine? I have serious doubts that is for personal use and if it is, they have a serious drug problem. Give me a rest, I don't know of ANY doc that would prescribe out all this !

First of all, I'm glad to hear you say you are enjoying the job and learning alot. You are obviously choosing to apply yourself and take an amazing learning opportunity. Kudos to you for wanting to further your education like that. I too have worked within ER (a level 1 trauma) and loved every single minute of it. It was a very different atmosphere and I found the aspect of caring for 10 patients at a time as opposed to 1 maybe 2 put triage into a whole new category ! I got to experience things I would never get the opportunity to be a part of on the street working, and while I left the ER to return to active EMS I became a much stronger person for it as I'm sure you will be. You will have a much better understanding of how to help your patients prior to arrival, because you will know what will be going on once they get there and why they do what they do. I've also had the opportunity to be included in learning opportunities like you mention, with one doc in particular who was a former paramedic frequently grabbing me for something interesting and using it as a teaching moment. Amazing - enjoy it ! As to the person who made the comment about nurses turning to the floor because they can't cut it in the ER - that is complete and total B.S. Some of the neonate nurses I know could run circles around some ER nurses with their knowledge, burn nurses have an amazing understanding of the complexities of burn patients, and ICU nurses make me stand up and go wow with their ability to relate with patients. Remember everyone has to start somewhere just as you did. ICU allows nurses an amazing amount of freedom, those guys and gals definitely know their stuff. I think you need to expand your research beyond your own four walls perhaps to see the whole picture before placing judgement IMHO. Be safe.

With the exception of specialty transports I've worked with, the services which have utilized "drivers" were absolute disasters. Most of them were 18-21 year old people that couldn't pass the national registry so in an attempt to give them something to do they gave these people with no drivers training the keys to basically an assault vehicle and told them happy trails. Well the end result was multiple wrecked trucks due to these yahoos going out of control sirens screaming on the worst of roads with the concept I'm bigger than you, therefore you must move or I'll make you move. After two wrecks, I got the heck out vowing never to return to concept again. I feel safe in the set up I have been in for several years - 25 to drive and extensive drivers training prior to being cut loose with 6 month hold time before you can even qualify to drive. Also, regular evaluations of driving records which so many employers seem to so kindly forget. Yeah, that's smart. Kentucky has resolved this problem a bit though by requiring the minimum requirement of certification for a driver to be a first responder for a BLS ambulance and my understanding is that may be increased. A majority of services here though are going to dual paramedics, if ALS unless very rural. It is really only the transfer services or BLS only counties which are utilizing this but they pay nothing anyway (minimum wage mostly or just above) so cost saving really isn't a benefit. I'm not seeing the benefit to a driver only category unless as dust said, they receive a commercial driver's license and then you will see a demand for higher pay. Not a solution, but creating another problem.